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General NPI Number Information
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NPI Number | 1528172590
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Entity Type | Organization
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Legal Business Name | FAMILY DENTISTRY OF NORTH PENSACOLA PA
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Dates
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Enumeration Date | 08/18/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 311 E NINE MILE ROAD FAMILY DENTISTRY OF NORTH PENSACOLA PA
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City | PENSACOLA
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State | FL
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Zip | 32514
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Country | US
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Telephone | 850-477-6934
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Fax | 850-476-0605
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Provider Business Mailing Address
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Address Line | 10433 TAM O SHANTER ROAD
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City | PENSACOLA
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State | FL
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Zip | 32514
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Country | US
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Telephone | 850-477-6934
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Fax | 850-476-0605
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Authorized Official
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Title or Position | PRESIDENT
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Name | PARVANEH MAHMOUDZADEH
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Credential | DDS
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Telephone | 850-477-6934
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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